Individual provider Active NPI

Jennifer Kim

  • Psychiatric/Mental Health Nurse Practitioner
  • Torrance, CA
National Provider Identifier
1639718323
Registry record updated May 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
NP95020590 Issued in CA
Practice address
1000 W Carson St
Torrance, CA 90502-2059
Phone
(424) 306-4386
NPI assigned
Dec 30, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 31, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NP95020590 CA Primary
Registered Nurse 163W00000X 95155332 CA

Addresses

Primary practice location

1000 W Carson St
Torrance, CA 90502-2059

Mailing address

1000 W Carson St
Torrance, CA 90502-2059
Phone (424) 306-4386

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220909002950 CA Practitioner - Nurse Practitioner 7618352758 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Usc Care Medical Group IncGroup PAC ID 0446157747, 1,378 clinicians

Practice addresses (Care Compare)

1520 San Pablo St
Los Angeles, CA 90033-5310
Phone (800) 872-2273

1520 San Pablo St 1St Floor N
Los Angeles, CA 90033-5310
Phone (800) 872-2273

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95155332CAMDRegistered Nurse
NP95020590CAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Usc Care Medical Group, Inc CurrentSince Oct 17, 2022 Accepting new patients
Mellow Medical Inc a Professional Corporation CurrentSince Aug 29, 2022 Accepting new patients
Usc Care Medical Group, Inc CurrentSince Oct 17, 2022 Accepting new patients

Locations

420 34th St
Bakersfield, CA 93301
Phone (661) 324-4647

1520 San Pablo St
Los Angeles, CA 90033
Phone (323) 442-5849

12301 Wilshire Blvd
Ste 512
Los Angeles, CA 90025
Phone (833) 427-3566

1520 San Pablo St
Ste 1652
Los Angeles, CA 90033
Phone (323) 442-6000

1520 San Pablo St
Lowr
Los Angeles, CA 90033
Phone (323) 442-7450

5201 Great America Pkwy
Ste 320
Santa Clara, CA 95054
Phone (323) 968-6182

8235 Santa Monica Blvd
Ste 302
West Hollywood, CA 90046
Phone (310) 892-4284

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/9357/brand/1/csg/1/fhir/r4

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1577664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653955200000",
    "number": "1639718323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 W CARSON ST",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905022059",
            "telephone_number": "424-306-4386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 W CARSON ST",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905022059",
            "telephone_number": "424-306-4386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JENNIFER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-30",
        "last_updated": "2022-05-31",
        "certification_date": "2022-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "NP95020590",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95155332",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Torrance, CA

Sources for this page

Verify at the official NPI Registry.